duty military, the case of having a dedicated supply system is, it seems to me, very much weaker. and that suggests a possible appeal of the option that our -- that alice just mentioned, which is to help families of active duty military have fair, well-financed access to the general health care system. now, in particular it seems to me that one should step back and perhaps look at this from the other side. we now have a health care system in which, if your income is less than four times the official poverty threshold, which for a family of four is now in the vicinity of $90,000 a year, scaled down for smaller families of course, you were eligible for subsidies, refundable tax credits, and assistance with cost-sharing on a sliding scale

that starts with an essentially complete coverage of what's called a silver health plan. and that is the premium that is charged for a health care plan that covers 70% of the covered health care services on an actuarial basis. plans can provide that coverage in different ways. many people also want more generous coverage, or they receive it through employer-sponsored plans, if you buy through a health exchange you can buy plans that cover up to 90% of the cost of coverage, which leaves relatively small

amounts for deductibles, there may not be any or cost-sharing, only for certain services. it's very generous coverage. perhaps not as generous as tricare is now described as being, but close. so the question i have is whether it wouldn't be desirable as part of the national health care system to provide for the base level of coverage to be a general responsibility not of the department of defense, but but of the overall healthcare system that is serving the rest of the population. now, for special reasons as part of compensation, the department of defense may want to provide more generous coverage than this silver health care package. they may want something approaching or even surpassing platinum coverage.

if that's the case, that is the responsibility of the defense department as an extra recruitment will benefit that is provided to attract the kinds of soldiers we want to have. if that is the case, then the defense department would have to consider, and i think it would be a close question, as to whether the most effective way to attract the kind of force we want to have is to spend money on a particularly generous health care plan, higher cash payments, or some other form of compensation. they would have to judge what was the best way to attract the force that the defense department needs. but my fundamental point here is this is a nation that has

embarked on achieving a degree of close to universal, and relatively uniform access to the health care system. that's a national obligation. it is not, in my view, a defense department obligation. it isn't clear to me why the basic across a tricare for non-active duty personnel really is a defense department responsibility. >> thank you very much. and that sets up a lot of the questions that, jack, you want to get at including the additional one of whether this overall system strikes you as relatively efficient or in need of fundamental reform. above and beyond issues of who was a beneficiary, what the packages are, how generous of those packages are. is the system itself in need of fundamental reform, and anything else you'd like to address please. >> i appreciate the introduction

as part of the august group of scholars but, unfortunately, i claim that mantle, because i come from this much more from the perspective of being a management consultant influenced by my experience as both a consumer in the past of military health care and as a businessman. i appreciate dr. woodson's comment about thinking innovatively about the workforce, the exception i would take it is i think the worst -- workforce is only one component of the system. and if we are going to change the military health system to be something better in the future, then we need to be thinking about it as an be thinking innovatively about all parts of this. i agree with henry that he -- that there are multiple populations when you think about this. you have the active duty population that i've never heard anybody who thinks you should of anything other than the best health care possible. and i think the civilian population benefits from that, certainly from history and burn centers and what we are saying -- seeing now with prosthetics

and traumatic brain injury. nobody does that better than the military, and we all benefit from things like that. but the second population is the dependent population. indeed, when i think about this from a management perspective and as a businessman, you have to be thinking about the benefits that you are willing to able to have for everyone. not everybody in the military is able to take advantage of the benefit of having full medical care covered for dependent. indeed, any of the people in the military are not dependent the -- and if the military benefit program is going to be fair, then you would think that you would have a baseline that everybody is covered at one level, and then those who decide they're going to have dependents, they are sharing in the costs with the dependent care in the future, much like it is done in any other business that we see.

it is rare that a business provides free health care for all of its employees and all of the dependents of its employees. and then the third population that henry talked about is that population that has retired from the military, and their dependents but only about 10% of the people who were in the military retire from the military. so we are not talking about huge numbers with military experience. those people, a majority of them go on to other careers, do other things, and have the opportunity to be able to enjoy health care either through the aca or through other employers. and, indeed, having a program where they can go in and get free health care, and do it as often as they want, seems to be a burden that the american people shouldn't have to bear.

i think there have been enough studies done to have let people know that as soon as you provide a free good for people, it will be used more. i think carla referenced that with the tricare costs, so we know that. and one of the ways in the country we're looking at getting health care costs under control is putting more of the burden, or the cost of health care, on to individuals. people are sharing more in the expenses of that, and, indeed, the co-pays and in the deductible that they have to pay. part of what the military is doing right now is looking at how they improve the lifestyle and the way people in the military think about their own health. i think that this is important, and the program dr. woodson has established get at some of the education. but i think it can't be just done by the people who are

responsible for health care. because so much of what occurs in the military is influenced by the leadership. we all know that smoking is bad. we all know that it has tremendous impact on the lives of people, and it costs a lot in the military health care system. we all know that obesity is bad, and it drives up the cost of all health care systems. and yet in the military we still subsidizes the sale of cigarettes in the exchange system so that it is far below what someone would pay if they went into a wal-mart or something like that to be able to buy it. i don't think you can keep everyone from smoking in the military but you certainly shouldn't subsidize it. i think the same thing in terms of the way the health habits of people. people in the military have weight standards that they have to maintain, which is a great

thing in order to be able to do, but it isn't always maintained by healthy eating habits that we know serves them. so we need a command to get involved in this in order to be able to do it in the future. innovation in the health system i think is an important thing. >> thank you very much. we are going to go to you now. i think we will take two questions at a time, because my guess is that once we get quite we will probably work with the a while appears so in the interest of getting a few of your comments on the table we will go straight to you, and two at a time. so the gentleman here in the fourth row, please. and then also here in the second row. >> good morning. i guess i'm always concerned when i hear some of the comments through the panel, appreciate your thoughts and expertise this morning, but when you're looking at the challenges that dod is

facing, why there's never any comments made about the real problem with acquisition reform out there. there's a well-publicized, well researched study by government accountability office, 500 billion in cost overruns which could really easily almost pay for the sequestration burden. why is it never addressed here, with the focus of the panel seems to go on as i would call it, the low-hanging fruit, we will go directly at the personnel side of it here, kind of bothered me on that part. the second part of the question is the same time we're reducing that, the uniform leadership has already put a letter up on the hill has been well-publicized and articles and where the uniform leadership in particular has asked for protections on

their pay and compensation, while at the same time to want to reduce it by the rank and file of the military which kind of bothers me insurance of disingenuous piece therefore leadership. so kind of concern about how you would address those things are going on here either those to -- we have not talked about either of those two, particularly the acquisition reform. >> as we go to the second question let me just take time to speak about military health care reform so that's why we're not talking about acquisition. the rest of your points and questions are serving worth addressing. sir, over to you. >> thank you for being here today. i am a war college fellow at georgetown, and i'm a health services officer often given for distinguished honor of moving reserve forces to and from active duty, based on the nation's needs. and i can tell you from my perspective that that's one of my most difficult challenges with the health care system is

moving reservists in and out of the systems. for lack of a better word very much like a patch quilt system built from the top down. very, very difficult. takes a lot of our time to deal with. so i want to ask you from your different perspectives or responsibilities if you were reform will include reconsidering how the reservists access the system? maybe come up with a fresh point of view and build it from the individual up because we know that in the future in dod reform, the reservists has to be part of the solution. using the reserve component is going to save us money ultimately, so if we could redesign the program where they get access to the system a

little easier, perhaps half benefits correlate with their social security number, they are as they are entitled or authorized to go into active duty, something like that approach perhaps. will reform eventually include a redesigning the program for reservists to access the system easier? >> also maybe i can at the end -- if something still needs be said at that point, or maybe you want to begin but i don't know what's better for you. here's a microphone. >> thank you for that question. one thing i was trying to allude to in my comment was just that. we need to re-examine a lot of cold war policies that don't allow us to tap into easily the rich pool of the - reservist. i'm a reservist, and i also was again assistant surgeon general for mobilization. i would go to projection platforms and i would hear from

reservists. i love the work. they are true patriots, don't hesitate to be called up, but hated the transition from active -- from an inactive to active duty. sort of the things i was alluding to, i use the example of buying 0.4 fte, is to create these comprehensive packages for select groups of reservists that you could bring them on easily as it helps them and then we could manage benefits better, just to start the discussion. thank you. >> bob? >> well, going to the gentleman's question about other issues and acknowledging, as mike said, theas focus on health care, there've been a variety of proposals that you are probably familiar with by the department, and i can't speak as a department official now, but as a former one who tried to look at ways to hold down costs, ranging from looking for ways to make do with fewer civilian employees, but also

affected many other activities, cutting back on contract payments and things may be contract work to look for lower prior activities, strategic sourcing, tried to gather together purposess to make use of departments by corporate acquisition reform was certainly part of the power. there are some fundamental constraints there in terms of the department's desire to continue to field weapons that are technically superior and rather limited amount of competition that we have, clearly the best way to hold down costs. there were a number of initiatives taken there. i think the fact we're focusing on health care today shouldn't be taken to mean that's the only thing that dod is looking at. looking at a variety of issues, including acquisition reform. >> other thoughts from the panelists to any of these questions? alice? >> i think there are a number of

transitions that have been alluded to, including the last one of what happens to reservists when they go on active duty, and that's clearly one. the transitions between dod and va, another one. and within the civilian sector of people moving from medicaid onto the exchange is as they -- exchanges as they change their incomes or the job security. so i think the general point is we've have to figure out how to have a common set of identifiers. so that if you move from one system to another, your record moves with you and they know who you are and what's happened to you and all that. it is clearly an imperative. and if we can think about these things as a national health system, as henry said, we may be able to make some progress, and

maybe with a system that really most people in and out of their different statuses. >> henry? concern >> concern was expressed about the fact that higher cost-sharing and restricting the medical benefit would fall disproportionately on the relatively lowly paid members of the military. at least that's the way i interpreted it. the health benefits is a big part of the compensation of a sergeant but it's not so big a part of the compensation of a colonel. so if you are raising the cost of health care, aren't you disadvantaging the more lowly spaced? i don't think that has to be the case at all. there are lots of ways to go about doing this. you can have an income related premium -- that's the essence of the way health reform works. you can have additional compensation in other forms that is part of the package of

changes in health benefits. so the issue of what the distribution of compensation is across different ranks is something one can decide separately from the question of how much of the cost of health care should be shouldered personally by people in the military, or their families. i think i'm with you on the distributional side of things, but i think it's a problem that can be dealt with. >> just add to that, the proposal the department did last year did have lower co-pays, for example, i think the fives , so there was an attempt to do just what you said, henry. great concern in the military of to take care of its more junior enlisted.

>> other questions? we will take two more. agree that there is opportunities for reform and compensation, and some of the ideas are worth considering. i guess my question is, within the context of the overall budget, can we ever get there, should we ever get there without a broader discussion on the drivers for the rest of the population impacting the cost of the budget? some of the same challenges exist without other entitlement rims, -- entitlement programs, and it will be difficult to get to the military piece politically without the appearance of balancing the budget on the back of the vets, without at the same time

addressing medicare and medicaid, rising entitlement and how we look at that going forward. >> my name is karen with the national military family association, and also the wife of an active duty army officer. i would like to understand more about your ideas for streamlining the military treatment facilities and transitioning the military beneficiaries into the aca. having lived in some of these sparsely populated areas there are also a lack of civilian resources on these areas. and if he were to offload you -- if you were to offload military beneficiaries into the medical community, what would the plan before ensuring that military families had adequate access to quality health care? >> before we take these questions, and, as you are aware we have an active secretary and

and former comptroller and other people who are brainstorming. since you are hearing different ideas and i just want to underscore that point. that is something alice was driving at earlier if you wish to begin with any of those questions. >> certainly one of the problems is there is political opposition to anything that looks like a benefit reduction to anyone and that applies to military retirees, to medicare beneficiaries and it's one of the reasons i think we are looking at these changes across the whole system at the same time. and it certainly is possible that medicare, which is at the moment having some success holding down costs, as is the

military, can survive over the longer term if it takes advantage of the payment reforms that will enable them to use the medicare beneficiaries to have better choices and the providers to have the incentive to use their resources more efficiently and that seems to be starting to happen. but the more we think of this as a national how do we solve the problem together question i think the more we can pull the specific groups that are worried about what happens to us together in a conversation. areas,sparsely populated i wasn't saying close down the military health system and throw them into inadequate civilian

facilities, but if you have areas which both the civilians and military are concerned that there are not facilities of each -- not enough facilities of either kind, this may be soluble together easier than it is soluble separately. it might involve putting -- in might involve using medullary -- military facilities, or or it might involve putting military veterans or whoever we are talking about in the system to create a larger beneficiary and more ability to support. >> other comments, or answers for these questions? ok, we will take the next 2. citizen iadd, as a

understand we need to give up other entitlement programs and think about the revenue side of government. i believe the joint chiefs and the secretary and the department of defense decided they need to look at compensation programs to include healthcare because the law limits the total military spending. if they don't slow the growth in military compensation they will , be less available for training and modernization and they are very concerned that there is an -- isn't adequate training right now coming off 2013 and sequestration. so that would be their answer. it seems a logical one to me that they need to look into the military because if you limit it to the total spending, we needed to find dollars for training and modernization. >> i'm going to quote my good friend who's an american enterprise institute scholar who likes to say in her sweet southern drawl that we have two sacred contracts with the men

and women in uniform in the way that abraham lincoln spoke of also as they are in uniform service but the other is to make sure they are the best prepared for the fight so when they fight, they live and the enemy dies. it's a better way to put it coming from her than coming from me but it's a good way to underscore the trade-off based on the current law and budgets to some extent between the different programs. yes, ma'am, and valuable come up -- and then we will come up here. i think you have a question of l?s wel >> are you factoring the fact that the military health care system can be much more efficient and lower cost than the civilian system just by using medicare hospital rates and by negotiating prices the

-- prices for drugs? the military system is less expensive than civilian health care and it can be made much more efficient still. >> that question, a second, and one more up here please. >> military spouse -- sorry. the question of moving military families onto the national healthcare system isn't being -- is it being taken into consideration when families go overseas, what is the ramification of moving them back to the dod, what is the expense of that, and the time constraint? >> that idea is one that we are framing here, some at a more theoretical level. i don't think it is an active proposal of anybody in the department at the moment to be clear. do you want to say more about that? race, as i said in my opening remarks there has , been progress on the score. they were not using medicare

rates in small hospitals and for outpatients, they were allowed to do that in the congress and that has had some savings in the drug pricing schedules, which the companies sued and lost and it was helpful to the department so there may be more there but i think it's important that we acknowledge there has been progress. defer toi will alice or henry on the exchanges. >> i wonder if i can draw you out on this issue of how efficient we should think of the health care system. you spoke to that already with some informative illustrations and i wondered if you wanted to comment more generally how you see those institutions. one thing i was struck at is i think there are 140,000 dod full-time employees in the dod health care system.

80,000-plus who are civilian and 60,000 who are military. it's a big organization and by some tricks it doesn't look expensive. i was just wondering if he -- if you wanted to add a word on that. >> by nature, the government is never going to be efficient. it isn't designed to be that way because there are things it has to do that no other health system has to do. it has to take care of the active-duty military. one of the problems we always have when we want to change any big organization is that the organizations tied the way that they've done things in the past and it becomes very difficult to be able to do change in but always drives people to be able to come up with that change is when they need to have the money to do other things. i think bob alluded to that when he said there is only so much money that the dod is allowed to spend it now under law, and so if they are going to spend more money modernizing we have to find other ways to be able to.

that the military goes to remote places and is deployed overseas and that there are challenges in being able to get medical care in some of those places. but holding onto places like i learned yesterday in the air force where they may be getting only ten people through a facility at a despicably in not anybody's interest. it's to be able to provide medical care because the cost of maintaining the facility is absurd in comparison to what you would want to be able to do. so when i talk about innovation and how you want to think about this i'm not trying to get to the most efficient way. that would become a very mechanical approach. but i think that if you are thinking about innovation, you have to start thinking about

ways that you can do things better for the future and be a link to let the past go. >> i want to go back to the issue of inefficiency in the reference was made to the impact of the price of care and the quantity of care expenditure equals price times quantity. simple inclusion. -- equation .it's about a quarter of a century since the largest social experiment that are carried out. i that was on the impact of cost sharing and premium differences and the use of healthcare. done by the rand corporation. it resulted in about 30% more use of healthcare services than did a normal health insurance

plan back then. we just heard the statistic that the iqs of healthcare under tricare, the quantity of service means that for comparable populations even larger. now if there were evidence that the difference in the quantity of care had a big impact on healthcare than you are into the business of doing trade-offs. is it worth it to spend more in order to get the additional benefits? the evidence is that the impact on health is negligible. there are some differences that we are detecting back a quarter of a century ago and i suspect you would find some if you did a comparable study today.

i think it is fair to ask if this is a good expenditure of funds by a cache strapped and perhaps not sufficiently trained and ready military at the present time. i would like to make one other comment to propose an inconsistency between the government and inefficiency. ten years ago a very careful study was done of the likelihood that people would receive the care indicated for the condition they had when they would go into a hospital and see a physician. tens of thousands of records were examined, and the results are quite startling. it didn't make a difference in

the likelihood that you would get the care that was recommended. it didn't make a difference if you are rich or poor, male or female, black or white. they were almost identical percentages. there was one place that stood out for having a probability of people receiving the care that was recommended. that was the veterans administration. that was the one part of the healthcare system that is health care system that is managed and run by the government. it used to be something of a sinkhole. it had a terrible reputation, but in the '90s the real revolution occurred in the delivery system. it was a pioneer in electronic

health records and it was way over its previous standard in at least this one study this holy government managed health care delivery system did a better job of delivering the recommended care than the rest of the healthcare system. now no doubt that the private sector particular places but if there's one group so i think it is the case that if they were in government or outside of the care given their heads and supported and given the flexibility to effectuate the reforms we can see efficiency in both places. >> thinking a similar thing along those lines but its price times quantity and that as an analyst i found it very challenging and i haven't really

seen one answer about whether in-house care is cheaper than private-sector care. i've seen practice patterns, how long does it take before you replace the need and the military system versus a long civilian way between how much physical therapy they have to take before they put in many. that sort of thing. hotel amenities and hospitals if you don't versus private rooms and so on and so forth. this is a very challenging -- the rates are fantastic when you can get them. and i do think that it's not really an easy one. >> that's right it reinforces the point that on the average there are a lot of improvements

that can be made across the system and we need to be thinking about them in the same way changing the incentive both for the providers and beneficiaries so that we get better healthcare health care for less money. >> that we will do a final round. >> thank you for your time today. i'm with the military officers association of america. i just had a comment about the two quotes that you had the military needing to be the best. and we need to take care of the people that are in uniform today and those in service. my husband is an active-duty marine and i most certainly understand the need for the military to be best prepared. but i noticed absent in that statement is that 10% that someone mentioned the 10% who

have given their life of service and sacrifice to the nation. and i wonder if the panelists could reiterate how they feel the nation has an obligation to them in terms of healthcare and to the retirees and also absent in that statement is the military families at the china military family member. what is it in terms of providing health care i would be interested in what each panelists thought about those obligations to the retirees and military families. >> i'm with the national military association and i'm also an active-duty family member. part of the rationale for including family members and retirees in the health care system is to ensure that military healthcare providers have a sizable diverse population to practice. so if we remove family members and retirees from the military health system either by on of these innovative ideas requiring

them to participate in the aca or by removing the financial incentives for them to be part of the military health system of impact would that have on the military providers and with their training and preparations suffer by not having this adverse population on which to practice. >> when someone comes into the military to the retirement age whether it is 20 years or 30 years. there is a contractual obligation to adhere to that. those people that are currently in the military and are going to the retirement of the meet that obligation. i don't think that that needs to be something that is perpetrated

far into the future. i think that there are obviously if it is cost considerations whether you can afford to do that or not you can change what the contract is and so you end up with a situation where you grandfather the ones that are already in the military that are providing different benefit systems for those future people who are going to be coming in. this is not inconsistent at all with what you find in every other place in a result of turmoil in wisconsin when the governor changed the contract agreement with public-sector employees that had been in place for some period of time. i'm not proposing doing something like that. i'm proposing looking at what the benefit is in the future. we need to be able to balance the benefits as a part of the total package of what you need in order to be able to continue

to attract the quantities and qualities, the skill set of people in order to be able to defend the country because we have a volunteer military and it's not a conscript any more. it is one of economics at how to give attract the people that you have and how do you keep the numbers that you need to have in the future and it's a combination of things that you're able to do and it doesn't have to be the same thing. >> we should distinguish what is the obligation to what kind of healthcare to the want people to have and the obligation to the active-duty military is something that has to be decided politically but it's whatever

obligation we have we want people to be in a system that is effective and not wasteful, duplicate event subject to problems and handoff between one facility and another. and one of the ways that people think we could get a more effective system is to have plans whether they are military or civilian competing against each other and for that you need a fairly large pool of beneficiaries. if you are thinking about the system as it holds you might want to put into play to

maximize the ability to deliver good care especially in these sparsely populated areas to everybody and think about how you use the facilities that are in the military to do that. that's all that i was suggesting. i think it is quite independent of what the subsidies are the various categories of the beneficiaries. >> in responding to this, first the details of the options that we explored are available on the website and those people that want to know, i would encourage you to look at that.

cbo.gov. i will say that for the options that we looked at, for example, the one option was to take what with the enrollment fee and the copayment of the if you took what they were in 1995 when try care was stood up and if they have kept pace had kept pace with the increase in per capita medical inflation what would they be today. so innocent taking the financial burden that was established for the retirees and for service members when it was stood up and keep the garden is a joy in the same adjusting for inflation and you double the enrollment fees that goes for maybe 550 a year for family coverage. and that's what you see is people do leave but not everybody leaves and people do consume fewer services but not everybody consumes so you have

these behavioral effects. i don't want to give the impression that somehow people are forced out of the system when you change the financial arrangement tricare will still look financially of these options took place it would still look financially attractive to many people. >> i think the department of defense recognizes that have an obligation to the retirees and active-duty family members and a proposed independent of the change that. they would take tricare from being largely having no copayments and what i would describe as modest for the most junior enlisted if i were member $20 if you go outside of the military treatment facilities that and many other proposals so about $2 billion a year and roughly half of that comes through the deductions and be

over utilization's that have been discussed already. it's only about half of it comes from the fees themselves. but i don't think there is any question that there remains a feeling it's a commitment. >> we will take one last round of questions and then i'm going to invite the panel starting with bob to respond if they wish but also to add any final concluding comment if there is something we want to hear today that we haven't yet. >> i'm with the military officers association and i'm a retired navy nurse and so i've been an assistant for 30 plus years. i know we've discussed in the past the cost of readiness. there is a cost and is of the

various forms. can you comment on that? >> thank you for everything you've said up there today. i am an army trauma nurse and two points i was concerned about is we talk about separating military health system and readiness. it goes to the war every day for the civilians in the area. we need to be cautious as we proceed on that road because we have to maintain our medical readiness to treat with or without a war. as dr. woodson stated, we deployed.

the second point i would like to ask is we talked about over utilization. on the try care benefits, has there been research into frivolous health care as in an appointment at that scene as actually frivolous usage and potentially once it is deemed as frivolous, that person would then pay a co-pay rate has there been a consideration to recoup some of those benefits? >> it's one of the hardest things to define. that's why at least the base portion for using those in conflict. you could take it to a much more limited thing that we should

back off of the specific numbers and recognize there is a strong commitment to readiness as the department of defense says there should be especially wary face as many facts that come up with a warning as they do in healthcare. i can tell you from personal experience that discussions are made about benefits and what we are going to do to the health care system and military readiness is something that always gets raised and it should be and will continue to be. >> i want to invite wanted to invite you to add anything that you would wish. given the responsibilities you have and how much you've contributed and realizing that you are now out of service in the department of defense i think i'm hearing you today say the military health care system

is in reasonably good shape but it needs a lot of work into the compensation system is reasonably fair but there are significant changes we can and should consider and we don't need an overhaul but we do need a lot of work in specific areas. is that a fair summary? >> brookings published the paper and it described the current system which is very complicated politics is the art of the possible. i don't see starting over in this kind of environment and therefore i would say if it is doing its fundamental role it is most realistic. but i would like to give the chance to talk about the emergency room care which you know better than i do. >> we will go down the road

first. >> i think the dod has tried to wrestle with the sort of things , i hate to call them frivolous, but certainly you will see the sort of plans that you outlined if you go to the er deductible is higher. i don't think those sort of things have been proposed officially. >> let me stick with reckless because that is such an unfortunate word usually and in this instance there are good studies that will tell you that

care coordination for chronic disease will help avoid running to the emergency room and it avoids getting into the condition that you have to go to the emergency room and some of these studies have to do with things you don't ordinarily think of as healthcare. we were looking at pediatric asthma and if you can get children into an environment with less mold and hazard in the household they are much less likely to have emergency room visits. that isn't a healthcare thing

. that it is a disease management that can save money. >> continuing again virtually any contact that you have with the medical system has some probability of helping. it's maybe a high parity to be compatible with the few walk with a broken arm. it's maybe a very low probability and there are some cases the harm is likely to occur. there is no clear distinction anywhere on the probability distribution of contact is in one case clearly indicated or not indicated so inevitably you

are making a decision about a policy change that has the effect of reducing the degree to which somebody uses healthcare there is some ability of benefit. -- rob ability of benefit. now the point that i think carla made or i made citing the health insurance study from many years ago is that within the u.s. healthcare system health care system there is an awful lot of contact with the healthcare system where the probability of the benefit is modest. so this isn't an on and off signal where you know it when you see it. it is an ambiguous and difficult decision. so, when we speak of changing

cost-sharing that will have some effect on people's willingness to demand care that usually goes with the fact that preventive care is free and vaccinations are free and low-cost sharing their because we know those pay off big-time but sure there is cost-saving for other things. sure there is some sort of trade-off but the evidence is a sacrifice from imposing some charges. >> i don't think there's any doubt that they are going over the transformation and it's not done yet. the aca has things that need to be fixed. the military does her duty to delivery service system will be part of that.

my experience in this town is the best solutions where all of the stakeholders can come together and recognize that there's going to be change and we need to work together to get that change possible. not exactly what each stakeholder wants. there are many members in this room today. i strongly encourage you to get in a fight not to justify or protect what you have but to establish what's right for the future for the country and your constituents. >> last word to you if you have anything you would like to add. >> it was about four times higher per capita in the department of defense and it is in the private sector. there is worry about the medical

effects but i think it is a concern on the surgeons general part of the follow-up care being heavily used. i would worry about trying to add adjudicated the use but i think that some kind of pace case for the emergency room use is appropriate. but me back off of the broad issue. we are doing a lot of good things for the country and we have a lot of men and women in uniform. and the civilians that support them. that includes healthcare, reasonable healthcare that i think all of us would agree to that. the discussion is can we do it more effectively whether it is to use the broad resources in the national system whether it is some changes and incentives or budgeting differently that is the debate that needs to happen. we are committed to a strong military health care system. we are all current beneficiaries

>> before we think the paneling sure you would want to join me in making sure that we are also also applauding the men and women in uniform, the families, retirees, veterans and everybody else who's contributed so much to the nation. thank you for being here and happy holidays. [applause] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2014] >> here is a look at some of the programs you will find christmas day on the c-span networks. atiday festive day started 10:00 eastern on c-span with the lighting of the national christmas tree followed by the white house christmas decorations with first lady michelle obama and the leading of the capitol christmas tree.

just after 12:30 p.m., celebrity activists talk about their causes. then at 8:00, samuel alito and john bush on the bill of rights and the founding fathers. on c-span two at 10:00 eastern, venture into the art of good writing with steve anchor. then see the feminist side of a e looksro as jill lepor into the secret history of wonder woman. c-spanican history tv on three at 8:00 eastern, the fall of the berlin wall with c-span footage of george bush and bob dole, with speeches from john kennedy and ronald reagan. at noon, fashion experts on her slighty fashion choices and how they represent the styles of the time they lived. tom former nbc news anchor brokaw on his more than 50 years of reporting on world events. that is christmas day on the c-span networks. for a complete digital, go to

www.c-span.org. >> coming up, we will take you like to the united nations security council meeting on north korea and. north korea will not be attending this meeting. during a meeting last week of the entire u.s. general assembly, 116 out of 189 countries voted for a resolution to accuse north korea of crimes against vanity. the security council today will be debating whether to refer north korea to the international terminal court. as a member of the council and ally of the country, china could use it ito today. north korean leaders have been accusing the united states of a leading. live coverage is expected to start shortly here on c-span. [captioning performed by the national captioning institute,

which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2014]

>> expecting this to start any moment now. the coming together for a meeting on north korea and human rights. , the entire week general assembly voted for a resolution accusing north korea of crimes against to maddie. whether the security council will refer north korea to the international criminal court. expected to start shortly here on c-span.

>> waiting for the un security council to begin its meeting here. working today on north korea and human rights, whether or not to refer north korea to the international criminal court for

crimes against humanity. in other news, here in the united states, congressman michael grimm in new york pleading guilty to a felony count of tax evasion. he was charged a 20 count indictment for hiding more than a million dollars in income and wages. pleading guilty on tuesday to a felony charge of cheating on his taxes with a restaurant he owns and manhattan that he co-owned before entering congress. congressman michael grimm pleading guilty to a felony count of tax evasion.

>> this meeting of the security council is called to order. the provisional agenda for this in the is the situation democratic people's republic of korea. does any member of the council wish to speak on the subject? to give the floor now to the representative of china. president, china is against using the existence of the large scale violence in the in theo include this

agenda of the security council. the you in charge stimulates explicitly that the primary responsibility of the security council is to maintain international peace and security. various u.n. organs have their respected functions and division of labor. the security council is not the forum to get involved in human rights issues and still less should the human rights issue be politicized. currently, we are faced with numerous forms and challenges. the security council should strictly abide by its responsibilities and concentrate whichressing issues concern international peace and security. the situation on the korean peninsula remains complex and sensitive. opposing the goal of denuclearization, maintaining peace and stability and

insisting on dialogue and consultations as a way to solve in the these are interest of all parties concerned and should be direction toward which all parties should work together. the security council should work more to facilitate dialogue and refrain fromand doing anything that might cause the escalation of tension. the inclusion by the security council in this agenda and by which to get involved in the dpr k human rights issue would go against the above goals and can only bring harm instead of benefits. thank you, mr. president. to thank theke representative of china for his statement. does any other member of the council wish to take the floor? i'm going to give the floor to

the representative of australia. >> mr. president, thank you and thank you for convening this meeting. i will make only a few brief remarks. like to start by reading the letters of the group of 10 councilmembers addressed to you, mr. president, in your capacity as president of the council on five, december, 2014. the letter stated -- "we the undersigned members of the security council, australia, chile, france, jordan, lithuania, luxembourg, republic of korea, rwanda, united kingdom, and the united states are deeply concerned about the situation in the democratic people's republic of korea. we are particularly concerned by the scale and gravity of human rights violations detailed in the comprehensive report undertaken by the u.n. human rights council commission of inquiry in the democratic

people's republic of korea -- document a contained in document -- these violations threaten to have a destabilizing impact in the maintenance of international peace and security. , we would like to request the situation in the democratic people's republic of korea be formally placed on the council's agenda without prejudice to the item on nonproliferation in the dpr k. meeting of the security council on the situation in democratic people's republic of korea, pursuant tool number two of the council -- the councils provisional rules of procedure and request a senior official from the u.n. secretariat and a senior official from the u.n. office of the high commissioner of human briefed at aly meeting of the security council under that agenda item.

which would enable councilmembers to receive further information from the secretariat on this station and its implications for international peace and security. that letter was issued as counsel document s. the 10 members of the council which signed the letters are seeking the establishment of a new agenda item, the situation in democratic people's republic necessary,nd as consider the deteriorating human rights system in that country. this systematic violations of human rights taking place in the dpr k and the threat to the maintenance of international peace and security, we do not consider this can be appropriately considered by the council on an ad hoc or informal basis. second, a formal council meeting

under the new agenda item must take place today. rule number two of the perceptional -- provisional rules of procedure provides why the president should call a meeting of the security council on the request of any one member of the council and it has been over two weeks since 10 councilmembers requested such a meeting. we should now proceed to adopt the agenda which has as its subsidy items the situation in the people's democratic republic thank you, mr. president. >> i would like to thank the representative of australia for his statement. attentiondrop members to the letter dated the cymer fifth, 2014. 2014/872 addressed to the

president of the security council from the representatives of australia, chile, the united states america, france, jordan, , theania, luxembourg republic of korea, the united kingdom, great britain, northern ireland and rwanda. in view of the request that this matter be included in the , in view ofagenda the comments made by the representatives of china and australia, i propose to put the provisional agenda to a vote. , i shall put it to a vote now.

favor of the adoption of the provisional agenda please raise their hands? thank you. those against? any abstentions? the results of the voting are as follows -- 11 votes in favor, two votes against, and to abstentions.

abstentions. the provisional agenda has been adopted. listen to the request of representative of australia, chile with the united states america, france, jordan, lithuania, luxembourg, the republic of korea, the united kingdom, great britain, ireland and rwanda contained in document that a meeting of the council of the agenda item, the korea be in the convened. i shall suspend this meeting and we shall resume after a brief

recess to continue consideration of the agenda item. the meeting is suspended.

>> the un security council working on a meeting here -- north korea's human rights record. north korea refusing to attend this meeting because of u.s. accusations of cyberattacks on sony pictures and the movie which portrays the assassination of its leader. bloomberg news reports and internet outage in north korea according to a network researcher. north korea's access to the internet hit with outages today and is off-line. north korea has four officials -- for official networks that connect through china and they began experiencing problems yesterday. today, they went completely black.

that's according to a company based in new hampshire. the un security council meeting here to decide whether or not to refer north korea to the international criminal court for human rights abuses.

>> the 7000 353rd meeting of the security council is resumed. 353rd meeting of the security council is resumed. following refers to participate in this meeting -- the assistant secretary general and thetical affairs,

assistant secretary-general for human rights. it is so decided. >> i'm going to give the floor now to mr. tate brooks, everyone.

>> mr. president, members of the security council, excellencies, ladies and gentlemen, the security council meets at a time when the situation in the democratic people's republic of korea is attracting increasing world attention and concern. the report of the secretary-general to the general assembly on the situation of human rights in the democratic people's republic of korea was issued earlier this month. adopted al assembly resolution on the human rights situation in the democratic people's republic of korea on 18 december and on 19, december, the federal bureau of investigation of the united states issued a report alleging the democratic people's republic

of korea was responsible for the recent cyber attack targeting sony pictures entertainment. awareecretary-general is of the fbi report. he is also aware that the democratic people's republic of korea has denied any involvement. privyited nations is not to the information on this -- on which the fbi's conclusions are made. the rise in the incidence and severity of cyberattacks is an increasing concern. mr. president, the commission of inquiry established by the human rights council gave voice to the many victims of human rights violations and provided a roadmap for democratic people's republic of korea to adhere to

universal standards. the commission concluded that -- and i quote "the gravity, scale and nature of the violations within the state that does not -- in the contemporary world." the tonession changed of the discussion on the democratic people's republic of korea. it is not just the nuclear issue that deserves international attention and action. a discussion in the security council today allows for a more comprehensive assessment and action in addressing the security and stability concerns and the korean peninsula -- in the korean peninsula. in keeping with its obligations to international law, the democratic people's republic of korea has a responsibility to protect its population from the most serious international

crimes. the international community also has a collective responsibility to protect the population of the democratic republic of korea and to consider the wider implications of the human rights situation for the stability of the region. mr. president, for the first time in 15 years, the foreign minister of the democratic people's republic of korea attended a general assembly december of this year and met with the secretary-general confirming the commitment of this country to sustaining and continuing the dialogue. the democratic people's republic of korea has also undertaken active diplomatic activities around the world including europe, east africa, and northeast asia and engaged or substantially with the united nations human right system, including a periodic review.

mode signals of engagement for an important opportunity for the united nations and the wider international community to redouble efforts toward building trust, dialogue, and cooperation on all tracks. it is also an opportunity for the democratic people's republic of korea to work with the international community to improve the human rights situation and the living conditions of the people of the country. mr. president, the democratic people's republic of korea has issued official statements making clear its objection to the general assembly resolution on the human rights situation in the country. and on the ninth of december, a spoke person for this poem -- for the foreign ministry gave a strong reaction to the meeting of the security council today. while the democratic people's republic of korea has raised the possibility of conducting a

fourth nuclear test in its statement immediately before and after the third, it's recent statements have the secretary notes that the -- cannot have the status of a nuclear weapons state in accordance with the treaty of nonproliferation of nuclear weapons. there is strong international consensus on the need for the various -- verifiable verification of the korean peninsula. remain a viable inghanism to maintain me denuclearization of the peninsula.

nonproliferation political, human rights, and security challenges are mutuallyted and reinforcing, the united nations urges member states to increase humanitarian assistance for in the democratic people's republic of korea. response nations' to the country is high-quality and life-saving with a measure eating imparted on the lives of the most vulnerable. the response however is hampered deficit which has been exasperated by sanctions. mr. president, next year marks the 70th anniversary of the end of the second world war, the founding of the united nations, as well as of the korean peninsula. the korean question has remained

unresolved for so long, in the situation on the peninsula remains fragile and volatile. remainedrean relations deadlocked, and family members have been separated for too long. a meaningful engagement would be an important step to overcome the current standoff in the korean peninsula and should go hand in hand with efforts to accountability. the united nations will continue its engagement on both fronts and counts on the active support of the international community, especially the countries in the region. sustained international efforts will be important in supporting these efforts. all concerned parties should work to make 2015 a pivotal year to improve human rights situation in the democratic

people's republic of korea and to move forward and denuclearize a peaceful korean peninsula. i think you, mr. president. you, mr. president. >> i would like to thank mr. zerihoun for his briefing. >> the high commissioner is sorry he could not address the council here today. mr. president, distinguished members of the council, earlier the representative of the democratic people's republic of korea spoke very vividly to agenessunsel about "sav and crimes against humanity committed against korean people during the second world war. " abduction, forcible

recruitment, and sexual slavery were lifted, which was said trembled on the dignity of korean women and the korean nation. this is the kind of compassion that we are seeking for the victims in the korean peninsula today. victims of extermination, of murder, enslavement, and torture, of rape, forced abortions, and other sexual violence. victims of persecution of and genderreligious, crimes, people who have been forcefully transferred, whose loved ones have been abducted or disappeared without trace, people who have been deliberately starved for long periods. according to the human rights

commission of the car, these cards have been widespread -- these crimes have been widespread, and in many instances they constitute crimes against humanity. the reporttoday is of that commission. extensive such an charge sheet of international crimes been brought to this council's-- attention. it documents the denial of freedom of thought, conscience, and religion, as well as the right to freedom of opinion, expression, information, and association. some pacification which calibrates perceived loyalty to stateate -- to the

generates discrimination throughout the country. where it intersects with gender-based discrimination nation, it increases the vulnerability of women and limits their opportunities. the dprk has also used the doubt to control itsd people. actions by officials have caused the deaths of hundreds of thousands of people, according to the commission, articulately during the famine of the 1990's and has inflicted permanent and psychological injuries on survivors. foodovember 2013, the u.n. and agricultural organization under the world food program found that 84% of households, 8 werefamilies out of 10,

not consuming enough food. according to the latest national 2012, 28%survey, in of children under 5 suffered stunting from now nutrition and almost one woman in four had been so start at she risked to giving birth to premature or underweight children. managed toals who flee the country may fall the two trafficking networks and often face prostitution. if forcibly returned, they face prostitution, and execution.y the commission expressed its deepest horror at the dprk's political prison camp system, whose inmates suffered

deliberate starvation, forced labor, executions, torture, if., forced abortion, and the commission estimated that hundreds of thousands of prisoners have pierced in these caps over the past 50 years and that they currently hold 80,000 to 120,000 people. dprk representatives have acknowledged the existence of what they term reformatories. i firmly believe that with honesty, transparency, and international assistance we can campa way to dismantle the system and release and rehabilitate prisoners. other countries in the region have shown it is possible to release thousands of political prisoners and role back systems rative detention.

the commission of inquiry has highlighted the connection between the human right system security in the region overall. the sustained military focus and nuclear priority of the government have been pursued at the expense of the economic and theal rights, as well as rights and well-being of its people. then rights violations by dprk have had significant impact on the regional peace and security, from international abductions and enforced disappearances to trafficking and the outflow of desperate refugees. are to reduce tensions in the region, there must a movement towards real respect of human rights in the dprk. this is deserving of the security council's posted tension and action.

excellencies, since the commission of inquiry report was published in march with the prospect of action right this council, the dprk authorities have shown promising new signs of engagement with international human rights mechanisms. its engaged productively in second universal periodic review in the human rights council and accepted numerous recommendations addressing humanitarian assistance, women and children's rights, health, and education. also heldsentatives an unprecedented meeting with a special representative. the dprk also indicated for the first time its willingness to accept technical assistance from -- more bilateral negotiations between the dprk and japan have reopened the investigations into alleged actions of japanese nationals.

i hope this process will be conducted in transparency and good faith, leading to truth and redress for the families. will also be important to bring clarity to reported abductions from the republic of korea and elsewhere. all these developments may present an opportunity for real change. other countries in the region have shown in the recent past that it is possible to dismantle deep-seated structural oppression and receive assistance in reform, leading to new recognition and standing in international communities. givefice will naturally all possible support to such progress, together with the international human rights mechanisms, and here i note that the special representative should be invited to visit dprk without preconditions. ohchr well15,

established a field-based demanded in seoul, as by a council resolution. this will follow up the commission of inquiry, boost support to the special representative, and serve as a hub for documentation and advocacy to advance accountability and improved human right in dprk. the real change in the human rights situation in a democratic republic of korea will require not only reform. it demands justice. for the first time, a u .n.-mandated body has qualified human rights violations in the dprk in terms of international criminal law. this is significant in establishing individual and institutional accountability,

but also invokes the international community's responsibility to take action to prevent and punish such crimes. an overwhelming majority of member states in the human rights council as well as general assembly, as well as victims, survivors these, and civil society organizations around the world, have asked that you, the security council of the united nations, take includingthis report, by referral to the international criminal court and by adopting targeted sanctions. year have seen this concerted actions by the international community can have a powerful deterrent effect and may begin to change the policy of dprk. i believe that the security crucialcan advance two

goals -- accountability and engagement for reform. today's discussion has placed the dprk on the notice. the council should carefully monitored and elements in the coming months to see whether engagement leads to real change or should take further action. distinguished members of the council, the people of dprk have endured decades of suffering and cruelty. they need your protection. and the cause of justice, peace, and security in the region requires your leadership. thank you. think mr. simonovic for his briefing. i now give the floor to the members of the council who wish to make statements. i give the floor to the

representative of australia. >> thank you, mr. president, and thank you to assistant secretary zerihoun. today plus meeting is an historic step for the international community's efforts to consider the situation in the dprk and its broader implications. it also sends a vital message to the people of north korea that the international community is aware of their suffering and stand in solidarity with them. the council recognizes that the dangerous threat to international peace and security posed by the dprk regime is not limited to its weapons program and proliferation activities, but that this threat also flows from the atrocious treatment of its people and its determination to use every means possible to resist action it perceives as a challenge to its authority. the dprk is in effect a

totalitarian state which uses violence and repression against its own citizens to maintain itself and its military apparatus in power. this has created an inherently unstable state. of regime's system repression enables its proliferation policies and its deprivations of its people from those policies. council say it has no business considering this issue, but australia disagrees. history shows that human rights violations of the type and scale we are seeing in north korea have reverberations well beyond the country in which they are committed. they mount to a rejection of --ernational norms which stable societies. as we have seen time and again, serious violations of human rights service as a warning sign of instability and conflict,

especially in the absence of accountabilities for such by a laois's. with the publication of the seminal report of the commission of inquiry on human rights in the dprk, the international community now has a evidence-based assessment of a systematic and white sprayed human rights violations being committed by the north korean regime. the report is deeply disturbing and compels a response. the commission's findings on the extent of the dprl' the holdam highlight on power. the program seeks to instill national hatred, constituting incitement to violence and propaganda for war. the commission's report lays bare the depraved nature of the tools of control, including the denial of access to basic human needs -- food,

water, heating, shelter, work. the massive humanitarian catastrophe that has resulted from the scale of the dprk's reign of terror has affected all the dprk's neighbors and threatens regional stability. there is a legal restriction on the freedom of expression. one witness told the commission that no one would their object to the harsh living conditions " protestrk, and, is equivalent to death." citizens are forced to denounce conduct that is perceived by the regime as a threat to it. family members must report on each other. surveillance apparatus interest harsh punishment for those who do not comply. the extreme militarization of the dprk has come at a devastating cost. the north korean people have paid for the world's fourth largest army and the development of nuclear weapons at it and increasingly sophisticated

missile system to deliver them with mass starvation and deprivation. the commission estimates that to 25% of itse up gross national product to defense expenditure, and yet the commission also finds malnutrition and starvation in the dprk could have been avoided through even a marginal redistribution of state military spending. the commission also found that entrenched patterns of discrimination based on uniquely issh class system which systematically applied to maintain control against perceived threats, external and in rural, and likewise the extreme restrictions on the freedom of movement within north korea and across its borders are designed to maximize state control. punishment of while asians are severe, often vicious and inhumane. women who are subjected to horrific discrimination resort international traffickers to escape.

the torturer they endure if they return cannot be regarded as a solely domestic concern. one of the cruelest policies of the regime is the system of political prison camps. an estimated 80,002 120,000 are imprisoned about trial in four political prison camps, and commission found that a majority, including children, had no prospect of ever being release. summary executions another cruel after judicial punishments lead to violations of cap roles, and torture is routine. thatimited information seeps up from the secret camps creates a specter of fear among the general population, creating a powerful deterrent against any future challenges to the political system. the commission found the information it received established that crimes against humanity have been committed in the dprk pursuant to policies established at the highest level of the state.

we strongly support the commission's conclusion that the international community must accept its responsibility to protect the people of north korea from crimes against humanity because the dprk government has manifestly failed to do so. the gravity, the scale, and the nature of these human rights violations distinguishes north korea as a state that in the words has no parallel in the contemporary world. the need for international response could not be more obvious. this view is clearly shared by a majority of u.n. member states who last thursday adopted 88 in the general assembly, which cemented the commission's report to this council for consideration and action. this is brought recognition by the you and membership that this responsibility on this issue, including to assure accountability for the crimes being committed. these crimes are integral political of the dprk

system. we must assume that crimes against humanity will continue if there is no international response. a core element of the commission's mandate is to ensure accountability for human rights violations, in particular ationsuch -- when such violenc are -- callederal assembly has on the council to consider this recommendation. australia believes that crimes against humanity documented in the commission's report warrant the intention of the international criminal court. in the absence of any move by the north korean regime to ensure accountability, the council should seriously consider this recommendation. mr. president, the north korean regime does have the power to change its behavior. most of the commission's recommendations are directed towards the dprk itself. recent indications of

a purported willingness to increase its cooperation with the international community on human rights will welcome -- are welcome, but those offers have since been withdrawn and there has been no sign of any internal reform. instead, the dprk has responded to the general assembly's call for it to engage on human rights issues by denouncing that call and indicating that it would engage in further hostile acts. when the dprk response human rights criticisms, threats to use nuclear weapons, it only strengthens the link between the dprk's human rights policies andinternational peace security. recent cyber attacks against international committees have been treated to the dprk. this is another example of the extraterritorial reach of their crimes, along with abductions of foreign nationals and demonstrates the extent to which it is prepared to defy international norms and aggressively seek to destabilize other countries and

international commerce. the international community's message to the dprk regime is direct. it must change course. it can take steps immediately to put an end to pu human rights violations in its country, which only further weakened the north the stabilityand of the state itself. it can commit to cooperate with the international community by extending full cooperation to the special representative on the situation of human rights in the dprk, including by granting in full, free, and unimpeded access to the dprk and by providing unfettered access to humanitarian agencies. there are options for the dprk regime, humane options, and we will continue to press its leadership to embrace them. the assistant secretary general has unloaded to some of them a moment ago. we are realistic about the brutal prospects for the north

korean people and what needs to be done to provide them a measure of protection. into new to look to those countries that have most influence on north korea, including those in the north asian region and other partners to continue to press the case for fundamental change to the dprk state apparatus. we know that this will not be easy. to conclude, the security council must also live up to its responsibilities in the accents of actions by the regime, particularly in relation to accountability for crimes against men at the. given the scale of the human rights violations and their links to international peace and security, it is essential that the council remains apprised of the situation. the council must regularly assess it situation and give it serious consideration to further action might take. in the interests of the north korean people themselves and in support of peace and security in their region and globally. thank you. i think the representative of

australia for his statement -- the representative of the australia for his statement. i now give the floor to the representative of the united states. >> thank you, mr. president, and thank you for your informative and appropriately bleak briefings and for the ongoing attention your respective teams give to the situation in the dprk in spite of persistent obstacles put up the north korean government. today's meeting reflect the growing consensus among councilmembers and u.n. never states that the widespread and systematic human rights violations been committed by the north korean government are not only deplorable in their own right, but also pose a threat to international peace and security. a major impetus for the security council taking up this issue was the comprehensive report issued

in february 2014 by the u.n. human rights council commission of inquiry. it conducted more than 200 confidential interviews with witnesses, eyewitnesses, and former officials and held public hearings in which more than 80 witnesses gave testimony. accounts were corroborated by other evidence, such as satellite imagery confirming the location of prison cap's. north korea denied the commission access to the country, consistent with its policy of routinely denied access to independent human rights and humanitarian groups, including the red cross and u.n. special representatives. refused to the dprk cooperate. the main finding of commission's thorough and objective report is that "systematic, widespread, and gross human rights violations have been and are being committed by the democratic people's republic of korea."

the commission found that the evidence it gathered provided reasonable grounds to determine crimes against humanity have been committed in the democratic people's republic of korea, resort to policies established at the highest level of the estate. if you have not watched any of testimonyof victims' or read from hundreds of pages of transcript from the public hearings, i urge you to do so. they show north korea for what it is, a living nightmare. a former prisoner of prison camp 15 said she and other prisoners were so famished that they picked kernels of corn from the dung of cattle to eat. she said if there was a day that we were able to have mouse, that was a special diet for us. we had to eat everything alive, every type of meat we could find, everything that flew, that crawled on the ground, any grass that group in the field.

a former guard at prison camp 22 spoke of guards routinely raping prisoners. in one case in which a victim became pregnant and gave worth, the former guard reported that prison officials cooked her baby and fed it to their dogs. this sounds unbelievable and unthinkable. if this is what a former guard told the commission of inquiry at a public hearing. his account fits and pattern across testimonies of sadistic punishment meted out to prisoners whose crime was being raped by officials. betweenission estimates 80000 and 120,000 people are being held in prison caps on like the ones where so many of these crimes occurred. any who testified before the commission were tortured as punishment for trying to flee north korea. one man who was in back to the dprk from china described being held in a prison cell that were only around 50 centimeters high,

just over a foot and a half. he said the guards told him because the prisoners were animals they would have to crawl like animals. a woman in the city of -- told how her brother tried to flee. when he returned officials found his hands and chained into the back of a truck before dragging him what he five kilometers, driving three loops around the city so everyone could see. his sister testified. when he fell down, he kept on driving. ors limited horri to prison camps. on december 18, the you and general assembly passed a resolution expressing grave concern at the commission's finding and